Healthcare Professionals as Bystanders in Workplace Bullying: A Mixed-Methods Systematic Review of Experiences,Behaviors,and Influencing Factors

Abstract

Background:

Workplace bullying in healthcare undermines employee well-being and patient care. Although bystanders can play a pivotal role in addressing bullying, their perspectives are often overlooked. This review aimed to synthesize the emotional experiences, behavioral responses, and influencing factors among healthcare professionals who witness workplace bullying.

Methods:

Guided by the Joanna Briggs Institute methodology for mixed-methods systematic reviews, this study used a convergent integrated approach to synthesize findings. A comprehensive search of seven international and three Chinese databases was conducted from inception to June 30, 2025, to identify relevant studies. Supplementary searches included Google Scholar and manual screening of reference lists. Eight studies (six qualitative and two quantitative) met inclusion criteria.

Results:

Four interrelated themes were identified: (1) Emotional and Psychological Impact—including moral distress, fear, and empathy; (2) Bystander Behavior—ranging from passive avoidance to active intervention; (3) Influencing Factors—such as organizational culture, peer dynamics, and individual moral reasoning; and (4) Intervention Dynamics—highlighting the perceived efficacy and barriers of anti-bullying programs.

Conclusions/Implications for Occupational Health Practice:

Bystander behavior is shaped by complex emotional, relational, and organizational dynamics. Understanding these dimensions is critical for advancing targeted interventions in occupational health. Occupational health professionals are well-positioned to implement multi-level strategies that empower bystanders. Interventions such as cognitive rehearsal, scenario-based simulations, and peer-led workshops can strengthen moral resilience and facilitate constructive responses. Fostering a culture of psychological safety and ethical leadership is essential to reducing bullying and supporting bystander engagement.